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Abstract

Background: Intracranial hemorrhage (ICH) remains a critical contributor to neonatal morbidity and mortality, particularly among preterm infants. Prompt and accurate diagnosis is essential to minimize neurological sequelae. While magnetic resonance imaging (MRI) is considered the gold standard for diagnosing ICH, its limited accessibility in emergency settings has positioned cranial ultrasound (US) as a viable, radiation-free, and bedside-compatible alternative for early detection.
Objective: To evaluate the diagnostic accuracy of intracranial ultrasound in detecting neonatal ICH, and to compare its performance across hemorrhage types and severity grades.
Methods: A prospective observational study was conducted in the neonatal intensive care unit (NICU) of CMH Rawalpindi, enrolling 71 neonates aged ≤28 days who presented with clinical suspicion of ICH. Each neonate underwent cranial ultrasound followed by confirmatory imaging—either computed tomography (CT) or MRI—within 48 hours. Ultrasound examinations were performed via anterior fontanelle using a 7.5–10 MHz transducer. Interpretation was carried out by a pediatric radiologist blinded to the CT/MRI results, which served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Subgroup analysis evaluated diagnostic performance across hemorrhage types (germinal matrix, intraventricular, parenchymal, subdural/epidural) and severity (Grade I–II vs. Grade III–IV).
Results: Cranial ultrasound exhibited a sensitivity of 85%, specificity of 92%, PPV of 88%, and NPV of 90% for detecting ICH. Sensitivity was highest for germinal matrix hemorrhage (89%) and severe hemorrhages (Grade III–IV, 93%), while lower rates were observed for parenchymal (78%), subdural/epidural hemorrhages (70%), and mild cases (Grade I–II, 80%).
Conclusion: Cranial ultrasound is a reliable, safe, and accessible first-line imaging modality for detecting neonatal ICH, particularly in severe and germinal matrix cases. However, confirmatory MRI or CT remains essential for comprehensive evaluation, especially for subtle or complex hemorrhage types.